Osteoarthritis
This lecture by Dr. Alison Walton occurred on Thursday, Notvember 4th. Back to RX 413 - Therapeutics Study Materials Required reading: *Buys LM, Elliott ME. Osteoarthritis. In DiPiro JP, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 7th ed. New York, 2008: 1519-1537 Handouts: *American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum. 2000;43(9):1905-1915. * Lanza FL, Chan FK, Eamonn MM, et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738. Panopto: * November 4th Panopto Objectives 'Explain the Etiology and pathophysiology of osteoarthritis and recognize the common risk factors' Pathopysiolgy Normal function of articular cartilage in joint space: *lubrication with motion *shock absorbency *load support *reduce friction Over time, events destabilize the normal cycle of synthesis and degredation involving articular artilage, chondrocytes, extracellular matrix, and subchondral bone. *Risk factors contribute to loss and/or damage of articular cartilage *biochemical, inflammatory, biomechanical, and immunologic factors are also involved. Clinical Presentation Symptoms *Pain localized to affected joint **Early disease = pain with motion **Late disease = pain at rest *Joint stiffness *Limited range of motion *Crepitus (crackling or grating sound) **caused by irregular surfaces of the joint rubbing together Physical findings *monoarticular - in young adult *Paurciarticular - in middle aged adults **affects large weight bearing joints **typically 1-4 joints involved *Polyarticular/Generalized OA - in middle aged or elderly adults **Most common **Affects many joints **Usually afflicts middle age adults 50+ *Joint Involvement (Primarily weight-bearing Joints) **Hand ***Distal Interphalangeal joint = Herberden's node ***Proximal interphalangeal joint = Bouchard's Node ***First carpometacarpal joint **Knee **Hip **Foot ***First metatarsophalangeal joint **Cervical and Lumbar Spine ***Often particularly painful *Physical examination of joints **Tenderness to palpitation **Effusions **Crepitus **Bony enlargement **Decreased range of motion **Malalignment *Laboratory Tests **There is no specific test to confirm the diagnosis of OA **Erythrocyte sedimentation rate (ESR) <20mm/hr **Rheumatoid factor negative **Evaluation of synovial fluid (WBC <2000 cells/mm3) ***Making sure that the inflammation is mild and localized *Radiographic Findings **Joint space Narrowing **Osteophytes Common risk factors for osteoarthritis include: Obesity - the number one preventable risk factor for OA *Strongly associated with hip, knee, and hand OA *Often precedes OA and contributes to development *Weight loss decreases future risk Occupation, Sports, Trauma related stress *Activites involving repetitive motion *workers exposed to repetitive stress through manual labor *Associated with sports injuries or joint trauma (even injuries early in life can increase later risk) Genetic factors *There has been some progress in identifying and understanding the contributions of genetic variation *opens opportunities for new medications 'Describe the clinical presentation and know the goals fo therapy for osteoarthritis' 'Develop and alter a treatment plan for pharmacologic and nonpharmacologic management of osteoarthritis' 'Design a treatment plan in patients with risk factors for gsatrointestinal, renal, or cardiovascular toxicity with NSAIDS' 'Identify drug and disease state interactions in patients with osteoarthritis' 'Recommend appropriate adjunctive and/or nonpharmacologic therapy in patients with osteoarthritis' 'For the following drugs, list the brand and generic names, therapetuic uses, usual starting doses, mechanism of action, monitoring parameters, common and or/clinically significant side effects, drug interactions and key points of patient education' 'Acetaminophen (Tylenol)' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Ibuprofen' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Naproxen' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Etodolac' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Indomethacin' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Meloxicam' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Nabumetone' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Sulindac' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Celecoxib' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Capsaicin' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Diclofenac Gel' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Glucosamine/Chondroitin' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Sodium Hyaluronate' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Tramadol' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education 'Flavocoxid' *Therapeutic use *Usual starting doses *mechanism of action *monitoring parameters *common/significant side effects *drug interactions *key points of patient education Back to RX 413 - Therapeutics